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PI3K Inhibitors in Cancer: Clinical Implications and Adverse Effects
International Journal of Molecular Sciences Review PI3K Inhibitors in Cancer: Clinical Implications and Adverse Effects Rosalin Mishra , Hima Patel, Samar Alanazi , Mary Kate Kilroy and Joan T. Garrett * Department of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, Cincinnati, OH 45267-0514, USA; [email protected] (R.M.); [email protected] (H.P.); [email protected] (S.A.); [email protected] (M.K.K.) * Correspondence: [email protected]; Tel.: +1-513-558-0741; Fax: +1-513-558-4372 Abstract: The phospatidylinositol-3 kinase (PI3K) pathway is a crucial intracellular signaling pathway which is mutated or amplified in a wide variety of cancers including breast, gastric, ovarian, colorectal, prostate, glioblastoma and endometrial cancers. PI3K signaling plays an important role in cancer cell survival, angiogenesis and metastasis, making it a promising therapeutic target. There are several ongoing and completed clinical trials involving PI3K inhibitors (pan, isoform-specific and dual PI3K/mTOR) with the goal to find efficient PI3K inhibitors that could overcome resistance to current therapies. This review focuses on the current landscape of various PI3K inhibitors either as monotherapy or in combination therapies and the treatment outcomes involved in various phases of clinical trials in different cancer types. There is a discussion of the drug-related toxicities, challenges associated with these PI3K inhibitors and the adverse events leading to treatment failure. In addition, novel PI3K drugs that have potential to be translated in the clinic are highlighted. Keywords: cancer; PIK3CA; resistance; PI3K inhibitors Citation: Mishra, R.; Patel, H.; Alanazi, S.; Kilroy, M.K.; Garrett, J.T. -
A Study of Abemaciclib (LY2835219)
A Study of Abemaciclib (LY2835219) in Combination With Temozolomide and Irinotecan and Abemaciclib in Combination With Temozolomide in Children and Young Adult Participants With Solid Tumors Status: Not yet recruiting Eligibility Criteria Sex: All Age: up to 18 Years old This study is NOT accepting healthy volunteers Inclusion Criteria: • Body weight ≥10 kilograms and body surface area (BSA) ≥0.5 meters squared. • Participants with any relapsed/refractory malignant solid tumor (excluding lymphoma), including central nervous system tumors, that have progressed on standard therapies and, in the judgment of the investigator, are appropriate candidates for the experimental therapy combination in the study part that is currently enrolling. • Participants must have at least one measurable (per Response Criteria in Solid Tumors [RECIST v1.1; [Eisenhauer et al. 2009] or Response Assessment in Neuro-Oncology (RANO) for central nervous system (CNS) tumors [Wen et al. 2010]) or evaluable lesion. • Participants must have had histologic verification of malignancy at original diagnosis or relapse, except: • Participants with extra-cranial germ-cell tumors who have elevations of serum tumor markers including alpha-fetoprotein or beta- human chorionic gonadotropin (HCG). • Participants with intrinsic brain stem tumors or participants with CNS-germ cell tumors and elevations of CSF or serum tumor markers including alpha-fetoprotein or beta-HCG. • A Lansky score ≥50 for participants ≤16 years of age or Karnofsky score ≥50 for participants >16 years of age. • Participants must have discontinued all previous treatments for cancer or investigational agents and must have recovered from the acute effects to Grade ≤1 at the time of enrollment. -
Cancer Drug Pharmacology Table
CANCER DRUG PHARMACOLOGY TABLE Cytotoxic Chemotherapy Drugs are classified according to the BC Cancer Drug Manual Monographs, unless otherwise specified (see asterisks). Subclassifications are in brackets where applicable. Alkylating Agents have reactive groups (usually alkyl) that attach to Antimetabolites are structural analogues of naturally occurring molecules DNA or RNA, leading to interruption in synthesis of DNA, RNA, or required for DNA and RNA synthesis. When substituted for the natural body proteins. substances, they disrupt DNA and RNA synthesis. bendamustine (nitrogen mustard) azacitidine (pyrimidine analogue) busulfan (alkyl sulfonate) capecitabine (pyrimidine analogue) carboplatin (platinum) cladribine (adenosine analogue) carmustine (nitrosurea) cytarabine (pyrimidine analogue) chlorambucil (nitrogen mustard) fludarabine (purine analogue) cisplatin (platinum) fluorouracil (pyrimidine analogue) cyclophosphamide (nitrogen mustard) gemcitabine (pyrimidine analogue) dacarbazine (triazine) mercaptopurine (purine analogue) estramustine (nitrogen mustard with 17-beta-estradiol) methotrexate (folate analogue) hydroxyurea pralatrexate (folate analogue) ifosfamide (nitrogen mustard) pemetrexed (folate analogue) lomustine (nitrosurea) pentostatin (purine analogue) mechlorethamine (nitrogen mustard) raltitrexed (folate analogue) melphalan (nitrogen mustard) thioguanine (purine analogue) oxaliplatin (platinum) trifluridine-tipiracil (pyrimidine analogue/thymidine phosphorylase procarbazine (triazine) inhibitor) -
Efficacy and Safety of Abemaciclib, an Inhibitor of CDK4 and CDK6, for Patients with Breast Cancer, Non–Small Cell Lung Cancer, and Other Solid Tumors
Published OnlineFirst May 23, 2016; DOI: 10.1158/2159-8290.CD-16-0095 RESEARCH ARTICLE Efficacy and Safety of Abemaciclib, an Inhibitor of CDK4 and CDK6, for Patients with Breast Cancer, Non–Small Cell Lung Cancer, and Other Solid Tumors Amita Patnaik1, Lee S. Rosen2, Sara M. Tolaney3, Anthony W. Tolcher1, Jonathan W. Goldman2, Leena Gandhi3, Kyriakos P. Papadopoulos1, Muralidhar Beeram1, Drew W. Rasco1, John F. Hilton3, Aejaz Nasir4, Richard P. Beckmann4, Andrew E. Schade4, Angie D. Fulford4, Tuan S. Nguyen4, Ricardo Martinez4, Palaniappan Kulanthaivel4, Lily Q. Li4, Martin Frenzel4, Damien M. Cronier4, Edward M. Chan4, Keith T. Flaherty5, Patrick Y. Wen3, and Geoffrey I. Shapiro3 ABSTRACT We evaluated the safety, pharmacokinetic profile, pharmacodynamic effects, and antitumor activity of abemaciclib, an orally bioavailable inhibitor of cyclin-dependent kinases (CDK) 4 and 6, in a multicenter study including phase I dose escalation followed by tumor- specific cohorts for breast cancer, non–small cell lung cancer (NSCLC), glioblastoma, melanoma, and colorectal cancer. A total of 225 patients were enrolled: 33 in dose escalation and 192 in tumor-specific cohorts. Dose-limiting toxicity was grade 3 fatigue. The maximum tolerated dose was 200 mg every 12 hours. The most common possibly related treatment-emergent adverse events involved fatigue and the gastrointestinal, renal, or hematopoietic systems. Plasma concentrations increased with dose, and pharmacodynamic effects were observed in proliferating keratinocytes and tumors. Radiographic responses were achieved in previously treated patients with breast cancer, NSCLC, and melanoma. For hormone receptor–positive breast cancer, the overall response rate was 31%; moreover, 61% of patients achieved either response or stable disease lasting ≥6 months. -
Phase I Trial of the PARP Inhibitor Olaparib and AKT Inhibitor Capivasertib in Patients with BRCA1/2- and Non–BRCA1/2-Mutant Cancers
Published OnlineFirst June 12, 2020; DOI: 10.1158/2159-8290.CD-20-0163 RESEARCH ARTICLE Phase I Trial of the PARP Inhibitor Olaparib and AKT Inhibitor Capivasertib in Patients with BRCA1/2- and Non–BRCA1/2-Mutant Cancers Timothy A. Yap1,2, Rebecca Kristeleit3, Vasiliki Michalarea1, Stephen J. Pettitt4,5, Joline S.J. Lim1, Suzanne Carreira2, Desamparados Roda1,2, Rowan Miller3, Ruth Riisnaes2, Susana Miranda2, Ines Figueiredo2, Daniel Nava Rodrigues2, Sarah Ward1,2, Ruth Matthews1,2, Mona Parmar1,2, Alison Turner1,2, Nina Tunariu1, Neha Chopra1,4, Heidrun Gevensleben2, Nicholas C. Turner1,4, Ruth Ruddle2, Florence I. Raynaud2, Shaun Decordova2, Karen E. Swales2, Laura Finneran2, Emma Hall2, Paul Rugman6, Justin P.O. Lindemann6, Andrew Foxley6, Christopher J. Lord4,5, Udai Banerji1,2, Ruth Plummer7, Bristi Basu8, Juanita S. Lopez1,2, Yvette Drew7, and Johann S. de Bono1,2 Downloaded from cancerdiscovery.aacrjournals.org on September 30, 2021. © 2020 American Association for Cancer Research. Published OnlineFirst June 12, 2020; DOI: 10.1158/2159-8290.CD-20-0163 ABSTRACT Preclinical studies have demonstrated synergy between PARP and PI3K/AKT path- way inhibitors in BRCA1 and BRCA2 (BRCA1/2)–deficient andBRCA1/2 -proficient tumors. We conducted an investigator-initiated phase I trial utilizing a prospective intrapatient dose- escalation design to assess two schedules of capivasertib (AKT inhibitor) with olaparib (PARP inhibi- tor) in 64 patients with advanced solid tumors. Dose expansions enrolled germline BRCA1/2-mutant tumors, or BRCA1/2 wild-type cancers harboring somatic DNA damage response (DDR) or PI3K–AKT pathway alterations. The combination was well tolerated. Recommended phase II doses for the two schedules were: olaparib 300 mg twice a day with either capivasertib 400 mg twice a day 4 days on, 3 days off, or capivasertib 640 mg twice a day 2 days on, 5 days off. -
Alpelisib Plus Fulvestrant in PIK3CA-Altered
Clinical Development BYL719 Clinical Trial Protocol CBYL719X2101 A phase IA, multicenter, open-label dose escalation study of oral BYL719, in adult patients with advanced solid malignancies, whose tumors have an alteration of the PIK3CA gene Authors Document type Amended Protocol Version EUDRACT number 2010-018782-32 Version number 09 (Clean) Development phase Ia Document status Final Release date 03-Dec-2015 Property of Novartis Confidential May not be used, divulged, published, or otherwise disclosed without the consent of Novartis Downloaded From: https://jamanetwork.com/ on 09/27/2021 Novartis Confidential Page 2 Amended Protocol Version 09 (Clean) Protocol No. CBYL719X2101 Table of contents Table of contents ................................................................................................................. 2 List of figures ...................................................................................................................... 5 List of tables ........................................................................................................................ 5 List of Post-text supplements (PTS) .................................................................................... 6 List of abbreviations ............................................................................................................ 7 Amendment 9 .................................................................................................................... 11 Oncology clinical study protocol synopsis ....................................................................... -
New Drug Update: the Next Step in Personalized Medicine
New Drug Update: The Next Step in Personalized Medicine Jordan Hill, PharmD, BCOP Clinical Pharmacy Specialist WVU Medicine Mary Babb Randolph Cancer Center Objectives • Review indications for new FDA approved anti- neoplastic medications in 2017 • Outline place in therapy of new medications • Become familiar with mechanisms of action of new medications • Describe adverse effects associated with new medications • Summarize dosing schemes and appropriate dose reductions for new medications First-in-Class Approvals • FLT3 inhibitor – midostaurin • IDH2 inhibitor – enasidenib • Anti-CD22 antibody drug conjugate – inotuzumab ozogamicin • CAR T-cell therapy - tisagenlecleucel “Me-too” Approvals • CDK 4/6 inhibitor – ribociclib and abemaciclib • PD-L1 inhibitors • Avelumab • Durvalumab • PARP inhibitor – niraparib • ALK inhibitor – brigatinib • Pan-HER inhibitor – neratinib • Liposome-encapsulated combination of daunorubicin and cytarabine • PI3K inhibitor – copanlisib Drugs by Malignancy AML Breast Bladder ALL FL Lung Ovarian 0 1 2 3 Oral versus IV 46% 54% Oral IV FIRST-IN CLASS FLT3 Inhibitor - midostaurin Journal of Hematology & Oncology 2017;10:93 Midostaurin (Rydapt®) • 717 newly diagnosed FLT3+ AML Patients • Induction and consolidation chemotherapy and placebo maintenance versus chemotherapy + midostaurin and Treatment maintenance midostaurin • OS: 74.7 mo versus 25.6 mo (P=0.009) Efficacy • EFS: 8.2 mo versus 3.0 mo (P=0.002) • Higher grade > 3 anemia, rash, and nausea Safety N Engl J Med 2017;377:454-64 Midostaurin (Rydapt®) • Approved indications: FLT3+ AML, mast cell leukemia, systemic mastocytosis • AML dose: 50 mg twice daily with food on days 8-21 • Of each induction cycle (+ daunorubicin and cytarabine) • Of each consolidation cycle (+ high dose cytarabine) • ADEs: nausea, myelosuppression, mucositis, increases in LFTs, amylase/lipase, and electrolyte abnormalities • Pharmacokinetics: hepatic metabolism, substrate of CYP 3A4; < 5% excretion in urine RYDAPT (midostaurin) [package insert]. -
Systemic Treatment Landscape and Algorithm for Hormone-Receptor Positive, HER2 Negative Advanced Breast Cancer
PRACTICE GUIDELINES 20 Systemic treatment landscape and algorithm for hormone-receptor positive, HER2 negative advanced breast cancer F. Derouane, MD1, K. Punie, MD2, F.P. Duhoux, MD, PhD1 SUMMARY Hormone-receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer accounts for 65% of all metastatic breast cancer (MBC) cases. With the advent of CDK4/6 inhibitors, single-agent endocrine therapy (ET) is no longer the only first-line systemic treatment option for the vast majority of patients presenting without visceral crisis. Other endocrine-based treatment options are emerging in further lines, with the goal to delay the administration of chemotherapy as long as possible. The optimal sequence of treatment is unknown. We here present a review of the available treatments and propose a treatment algorithm taking into account the latest therapeutic developments. (BELG J MED ONCOL 2021;15(1):20-33) Breast cancer remains the leading cause of cancer and cancer- incurable disease. The goal of treatment is to improve di- related death among women in Europe.1–3 Among patients sease-related symptoms but also to prolong survival while with metastatic breast cancer (MBC), the luminal B sub- maintaining a good quality of life. Several promising treat- type (hormone-receptor positive/ human epidermal growth ments have emerged in recent years, improving the quality factor receptor 2-negative (HR+/HER2-) and the HER2 po- of life (QoL) and survival in our patients. sitive subtype have the highest rate of primary -
Optimizing Binding Kinetics in Medicinal Chemistry: Facts Or Fantasy?
Optimizing Binding Kinetics in Medicinal Chemistry: facts or fantasy? ‡ -Gon /RT kon e -G‡ /RT ‡ off ΔG on koff e -ΔGd/RT Kd e koff /kon P + L ‡ ΔG off ΔGd PL Gerhard Müller Ex-Head of Med Chem Mercachem, Nijmegen, NL Binding coordinate 11 The topic is hot, complex, and I am just an end-user & controversial “You can’t optimize koff, and you don’t need to optimize koff, you simply need to optimize Kd ! ” Head Med Chem, (top-5 Pharma), West Coast, US, Jan 2016 Optimizing Binding Kinetics in Medicinal Chemistry: facts or fantasy? ‡ -Gon /RT kon e -G‡ /RT ‡ off ΔG on koff e -ΔGd/RT Kd e koff /kon P + L ‡ ΔG off ΔGd PL Gerhard Müller Chief Scientific Officer Gotham Therapeutics, New YorkBinding coordinate 2 confidential Streetlight effect in medicinal chemistry Top-heavy distributions, rich-get-richer mechanisms 5% / 75% J. Med. Chem., 54 ,6405–6416 (2011) Vertex Pharmaceuticals, US J. Org. Chem. 73, 4443-4451 (2008) MW clogP shape clogP flatness Fsp3 flatland J. Med. Chem., 58, 2390−2405 (2015) para meta ortho J. Med. Chem., 59, 4443–4458 (2016) 3 Cheminformatics Analysis – Kinase Family Ligand and target promiscuity (ChEMBL21) Hu, Kunimoto, Bajorath Chemical Biology & Drug Design, 89, 834-845 (2017) quantitative kinome coverage 270 kinases with high-confidence data Top-10 kinases (45% of human kinome still unexplored) VEGFR2 TK 2239 erbB1 TK 1814 22.537 distinct IC50 values p38a CMGC 1509 9191 distinct scaffolds HGFR TK 1411 31.873 kinase-inhibitor combinations PI3a lipid 844 erbB-2 TK 768 GSK3b CMGC 743 SRC TK 709 Chk1 CAMK 693 -
New Medicines Decisions APRIL 2019 – MARCH 2020
NHS Borders: New Medicines Decisions APRIL 2019 – MARCH 2020 Please note: We are happy to consider requests for other languages or formats. Please contact Pharmacy Admin Office [email protected] In Scotland, a newly licensed medicine is routinely available in a health board only after it has been: • accepted for use in NHSScotland by the Scottish Medicines Consortium (SMC), and • accepted for use by the health board’s Area Drug and Therapeutics Committee (ADTC). All medicines accepted by SMC are available in Scotland, but may not be considered ‘routinely available’ within a particular health board because of available services and preferences for alternative medicines. ‘Routinely available’ means that a medicine can be prescribed by the appropriately qualified person within a health board. Each health board has an ADTC. The ADTC is responsible for advising the health board on all aspects of the use of medicines. Medicines routinely available within a health board are usually included in the local formulary. The formulary is a list of medicines for use in the health board that has been agreed by ADTC in consultation with local clinical experts. It offers a choice of medicines for healthcare professionals to prescribe for common medical conditions. A formulary can help improve safety as prescribers are likely to become more familiar with the medicines in it and also helps make sure that standards of care are consistent across the health board. How does the health board decide which new medicines to make routinely available for patients? The ADTC in a health board will consider national and local guidance before deciding whether to make a new medicine routinely available. -
Combined Pi3kα-Mtor Targeting of Glioma Stem Cells
www.nature.com/scientificreports OPEN Combined PI3Kα‑mTOR Targeting of Glioma Stem Cells Frank D. Eckerdt1,2*, Jonathan B. Bell1, Christopher Gonzalez1, Michael S. Oh1, Ricardo E. Perez1,3, Candice Mazewski1,3, Mariafausta Fischietti1,3, Stewart Goldman1,4, Ichiro Nakano5 & Leonidas C. Platanias1,3,6 Glioblastoma (GBM) is the most common and lethal primary intrinsic tumour of the adult brain and evidence indicates disease progression is driven by glioma stem cells (GSCs). Extensive advances in the molecular characterization of GBM allowed classifcation into proneural, mesenchymal and classical subtypes, and have raised expectations these insights may predict response to targeted therapies. We utilized GBM neurospheres that display GSC characteristics and found activation of the PI3K/AKT pathway in sphere‑forming cells. The PI3Kα selective inhibitor alpelisib blocked PI3K/AKT activation and inhibited spheroid growth, suggesting an essential role for the PI3Kα catalytic isoform. p110α expression was highest in the proneural subtype and this was associated with increased phosphorylation of AKT. Further, employing the GBM BioDP, we found co‑expression of PIK3CA with the neuronal stem/progenitor marker NES was associated with poor prognosis in PN GBM patients, indicating a unique role for PI3Kα in PN GSCs. Alpelisib inhibited GSC neurosphere growth and these efects were more pronounced in GSCs of the PN subtype. The antineoplastic efects of alpelisib were substantially enhanced when combined with pharmacologic mTOR inhibition. These fndings identify the alpha catalytic PI3K isoform as a unique therapeutic target in proneural GBM and suggest that pharmacological mTOR inhibition may sensitize GSCs to selective PI3Kα inhibition. Glioblastoma (GBM), classifed as WHO grade IV glioma, is the most prevalent and malignant primary brain tumour and is essentially incurable 1. -
Dual Targeting of CDK4/6 and BCL2 Pathways Augments Tumor Response in Estrogen Receptor–Positive Breast Cancer James R
Published OnlineFirst April 3, 2020; DOI: 10.1158/1078-0432.CCR-19-1872 CLINICAL CANCER RESEARCH | TRANSLATIONAL CANCER MECHANISMS AND THERAPY Dual Targeting of CDK4/6 and BCL2 Pathways Augments Tumor Response in Estrogen Receptor–Positive Breast Cancer James R. Whittle1,2,3, Francois¸ Vaillant1,3, Elliot Surgenor1, Antonia N. Policheni3,4,Goknur€ Giner3,5, Bianca D. Capaldo1,3, Huei-Rong Chen1,HeK.Liu1, Johanna F. Dekkers1,6,7, Norman Sachs6, Hans Clevers6,7, Andrew Fellowes8, Thomas Green8, Huiling Xu8, Stephen B. Fox8,9, Marco J. Herold3,10, Gordon K. Smyth5,11, Daniel H.D. Gray3,4, Jane E. Visvader1,3, and Geoffrey J. Lindeman1,2,12 ABSTRACT ◥ Purpose: Although cyclin-dependent kinase 4 and 6 (CDK4/6) Results: Triple therapy was well tolerated and produced a super- inhibitors significantly extend tumor response in patients with ior and more durable tumor response compared with single or þ metastatic estrogen receptor–positive (ER ) breast cancer, relapse doublet therapy. This was associated with marked apoptosis, includ- is almost inevitable. This may, in part, reflect the failure of CDK4/6 ing of senescent cells, indicative of senolysis. Unexpectedly, ABT- – inhibitors to induce apoptotic cell death. We therefore evaluated 199 resulted in Rb dephosphorylation and reduced G1 S cyclins, combination therapy with ABT-199 (venetoclax), a potent and most notably at high doses, thereby intensifying the fulvestrant/ selective BCL2 inhibitor. palbociclib–induced cell-cycle arrest. Interestingly, a CRISPR/Cas9 Experimental Design: BCL2 family member expression was screen suggested that ABT-199 could mitigate loss of Rb (and assessed following treatment with endocrine therapy and the potentially other mechanisms of acquired resistance) to palbociclib.